Communicating with children with autism spectrum disorder and their families: a practical introduction

Impaired communication and social interaction are symptoms central to autism spectrum disorder (ASD). Children or young people with ASD have varied intellectual ability, learning difficulty, and needs. For caregivers and health care professionals providing care to children with ASD, many challenges are encountered in everyday conversations. Enhanced knowledge of the spectrum and understanding the child or young person with ASD may improve conversation and social experiences. This article provides a practical introduction for health professionals seeking to improve their interaction with young people with ASD. Fictional vignettes, in which children with ASD are seeking care and support are presented, followed by discussion on communicating with children with ASD.     

Walking Ability is Associated with Social Communication Skills in Infants at High Risk for Autism Spectrum Disorder

Achievement of early motor milestones in infancy affords new opportunities for social interaction and communication. Research has shown that both motor and social deficits are observed in infants who later develop autism spectrum disorder (ASD). This study examined associations between motor and Social communication skills in 12‐month‐old infant siblings of children with ASD who are at heightened risk for developmental delays (N = 86) and low‐risk, typically developing infants (N = 113). Infants were classified into one of three groups based on their walking ability: walkers (walks independently), standers (stands independently), or prewalkers (does not yet stand or walk independently). Social communication and cognitive skills were assessed with two standardized assessments (Communication and Symbolic Behaviors Scales [CSBS] and Mullen Scales of Early Learning) and compared across the three walking groups. Results demonstrated that high‐risk walkers showed superior Social communication skills, but commensurate cognitive skills, compared to high‐risk prewalkers. In contrast, Social communication and cognitive skills were largely comparable for low‐risk infants, regardless of walking status. Findings suggest that for high‐risk infants, who are already vulnerable to developmental delays and ASD, independent walking may facilitate the emergence of Social communication abilities. Pivotal motor milestones may serve as useful indicators of Social communication delays and targets for intervention.     

Spirituality in Latino families of children with autism spectrum disorder

Research on Latino parents of children with intellectual and developmental disabilities (IDD) suggests that these parents often use spirituality to conceptualize and to cope with their child’s diagnosis. However, there are no studies that examine religion among Latino parents of children with autism spectrum disorders (ASD). The current study explores how Latino parents of children with ASD incorporate spirituality into their conceptualizations of their child’s disability. In the current study, 34 Latina mothers of children with ASD were interviewed about autism-related services, family characteristics, and cultural beliefs including spiritual beliefs. Thematic analysis of the transcribed interview data relating to spiritual beliefs was conducted for the present study. Most mothers endorsed beliefs that their child with a disability was a message from God. Within this theme, mothers reported beliefs that their child was a blessing from God, a test from God, a sign from God or that the parent was special. Other parents believed that having a child with a disability was not an act of God, but related to biomedical factors, and another group of parents was unsure about the spiritual meaning of their child with a disability. Lastly, some mothers reported that their larger cultural group believed that having a child with a disability was a punishment or a negative sign from God but they markedly rejected that conception. These findings suggest that providers working with Latino families of children with ASD should acknowledge the importance of spirituality for these families.     

The Development of Referential Communication and Autism Symptomatology in High‐Risk Infants

Non‐verbal referential communication is impaired in children with autism spectrum disorders (ASD). However, the development of difficulties with referential communication in the younger siblings of children with ASD (High‐Risk Siblings)—and the degree to which early referential communication predicts later autism symptomatology—is not clear. We modeled the early developmental trajectories of three types of referential communication: responding to joint attention (RJA), initiating joint attention (IJA), and initiating behavioral requests (IBR) across 8, 10, 12, 15, and 18 months of age in High‐Risk Siblings (n = 40) and the infant siblings of children without ASD (Low‐Risk Siblings; n = 21). Hierarchical linear modeling indicated that High‐Risk Siblings exhibited lower levels of baseline RJA and IJA and a lower rate of linear change in IBR than Low‐Risk Siblings. When the 10 High‐Risk Siblings who received an ASD diagnosis were excluded from analyses, group differences in the development of referential communication remained significant only for RJA. Baseline levels of IJA were associated with later ASD symptomatology among High‐Risk Siblings, suggesting that individual differences in referential communication development at 8 months may index early manifestations of ASD.     

Barriers and facilitators of the transition to adulthood for foster youth with autism spectrum disorder: Perspectives of service providers in Illinois

The lack of established and well-evaluated models of coordination between child welfare agencies and other public institutions presents lingering challenges to preparing foster youth to make the transition to adulthood. This may be particularly true for foster youth with developmental disabilities who must exit child welfare systems and enter into adult service systems, if eligible. The qualitative study we present explores the barriers and facilitators of the transition to adult service systems from the perspectives of service providers. Due to the rising prevalence of autism spectrum disorder (ASD) in the general population, focus groups were specifically conducted to better understand the transition of foster youth with ASD. Barriers included perceptions of two separate systems and abrupt transitions; a lack of training, identification, and tracking of autism; and confusion about services and funding. Facilitators included persistence and professional relationship building, and consistent communication and information sharing. Implications for improving the transition to adult service systems are discussed.     

Autism Spectrum Disorder: The Impact of Stressful and Traumatic Life Events and Implications for Clinical Practice

Research findings suggest that behavioral interventions are effective in improving educational outcomes and fostering skill development in people with autism spectrum disorder (ASD). However, high rates of comorbidity between ASD and other psychological disorders, including depression and anxiety, indicate that standard behavioral approaches are not adequately addressing issues related to mental health in this population. Research emerging since the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is advancing our understanding of the nature of childhood stress and trauma in people with ASD and its subsequent impact on mental health and wellbeing. Mounting evidence for stress and trauma as a risk factor for comorbidity and the worsening of core ASD symptoms may intimate a shift in the way clinical social workers and other clinical practitioners conceptualize and approach work with this population to include trauma-focused assessment strategies and clinical interventions. Future directions for research to better understand the nature of childhood stress and trauma and improve mental health in this population are also discussed.     

Appreciating the world of autism through the lens of video interaction guidance: an exploration of a parent’s perceptions,experiences and emerging narratives on autism

This study seeks to identify understandings and narratives around autism spectrum disorder (ASD) through the application of video interaction guidance (VIG). In adopting a social constructionist approach, the case study used a person-centred model to explore a parent’s experiences and emerging narratives of ASD through the lens of VIG. Findings of the current study suggest that VIG offers an effective tool for in-depth exploration of complex, multi-storied understandings of ASD and the perceived parental role. The intervention was perceived to promote greater awareness of the child’s communication skills, beyond the ‘common’ understandings of ASD, by providing a novel outsider perspective on interactions. The intervention also promoted parental efficacy through recognition of parenting skills in supporting the development of strength-based narratives. VIG was seen to provide a platform for an exploration of existing narratives and the construction of new, preferred realities.     

Learning About the Lived Experiences of Women with Autism from an Online Community

The experience of being an adult female with an autism spectrum disorder (ASD) has been understudied in social work literature. The purpose of this study was to develop an understanding of females with ASD, from their perspective, by examining content from an online autism community Web site. Using a phenomenological approach, data analysis on content obtained from the forum revealed several themes about the women’s experiences concerning the diagnostic process, managing and understanding symptoms, and the impact of ASD on their personal and work relationships. Implications for social work practice, including creating more effective services for females with ASD, are discussed.     

The Effect of Joint Control Training on the Performance of Multiply Controlled Behavior: A Systematic Literature Review Relevant to Children With Autism Spectrum Disorder and Other Developmental Disabilities

Skinner (1957) differentiated the roles of the speaker and the listener in a verbal encounter. Although not extensively emphasized, Skinner suggested an individual often behaves verbally even when responding as a listener. Children diagnosed with autism spectrum disorders (ASD) often display the absence of important, and basic verbal repertoires that limit their ability to engage in a variety of social skills or problem-solving skills. Joint control suggests that multiply controlled verbal responding involves functional control of two 2 or more stimuli or verbal operants. This systematic literature review provides a summary of publications specifying the relation and implications of the analysis of joint control and joint control training in the acquisition of multiply controlled, non-speaker behaviors (e.g., selection-based behavior; , sequencing behavior). The synthesis suggests that joint control training presents as a promising analytic tool in guiding interventions to teach complex, multiply controlled verbal and non-verbal repertoires to children diagnosed with autism ASD and/or other developmental disabilities. Recommendations for future research in joint control, as well as the implementation of joint control training, are provided.

     

Object exploration during the transition to sitting: A study of infants at heightened risk for autism spectrum disorder

Learning to sit promotes infants' object exploration because it offers increased access to objects and an improved position for exploration (e.g., ). Infants at heightened risk (HR) for autism spectrum disorder (ASD) exhibit delays in sitting and differences in object exploration. However, little is known about the association between sitting and object exploration among HR infants. We examined changes in object exploration as HR infants (N = 19) and comparison infants with no family history of ASD (Low Risk; LR; N = 23) gained experience sitting independently. Infants were observed monthly from 2.5 months until 1 month after the onset of independent sitting. At 12, 18, 24, and 36 months, infants completed standardized developmental assessments, and HR infants were assessed for ASD symptoms at 36 months. Although HR infants began sitting later than LR infants, both groups increased time spent grasping, shaking, banging, and mouthing objects as they gained sitting experience. Groups only differed in time spent actively mouthing objects, with LR infants showing a greater increase in active mouthing than HR infants. Findings suggest that HR infants experience a similar progression of object exploration across sitting development, but on a delayed time scale.     

Serving the needs of immigrant families of children with autism

The growing influx of immigrant families into the USA necessitates an understanding of how these families manage mental health disorders. Few studies have documented the ways in which autism spectrum disorders (ASD) are understood across different immigrant groups. This lack of knowledge creates barriers for practitioners who are encountering immigrant families in their practice. The present paper provides a conceptual framework of how cultural values and beliefs shape the way diagnosis, etiology and treatment of ASD is perceived by both immigrant families and western practitioners and how differences in perspectives may create obstacles in treatment planning. A review of the literature describing practical and cultural barriers to mental health access and research among immigrant populations is also presented. Finally, recommendations are offered to practitioners, families and individuals with ASD to aid in increasing understanding and collaboration among these populations when designing and implementing treatment interventions.     

Fiscal Mapping Autism Spectrum Disorder Funds: A Case Study of Ohio

Individuals with autism spectrum disorders (ASDs) have complex needs requiring regular service utilization. Policymakers, administrators, and community leaders are looking for ways to finance ASD services and systems. Understanding the fiscal resources that support ASD services is essential. This article uses fiscal mapping to explore ASD funding streams in Ohio. Fiscal mapping steps are overviewed to assist ASD stakeholders in identifying and examining ASD-related funding. Implications are drawn related to how fiscal mapping could be used to identify and leverage funding for ASD services. The resulting information is critical to utilizing existing resources, advocating for resources, and leveraging available funds.     

An Empirical Study of Personality Disorders Among Treatment-Seeking Problem Gamblers

The primary aims of this study were to examine the prevalence of personality disorders in problem gamblers, to explore the relationship between personality disorders and problem gambling severity, and to explore the degree to which the psychological symptoms highlighted in the biosocial developmental model of borderline personality disorder (impulsivity, distress tolerance, substance use, PTSD symptoms, psychological distress and work/social adjustment) are associated with problem gambling. A secondary aim was to explore the strength of the relationships between these symptoms and problem gambling severity in problem gamblers with and without personality disorder pathology. Participants were 168 consecutively admitted problem gamblers seeking treatment from a specialist outpatient gambling service in Australia. The prevalence of personality disorders using the self-report version of the Iowa Personality Disorders Screen was 43.3 %. Cluster B personality disorders, but not Cluster A or C personality disorders, were associated with problem gambling severity. All psychological symptoms, except alcohol and drug use, were significantly higher among participants with personality disorder pathology compared to those without. Finally, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for problem gamblers with personality disorder pathology, while impulsivity, psychological distress, and work and social adjustment were significantly associated with problem gambling severity for those without personality disorder pathology. High rates of comorbid personality disorders, particularly Cluster B disorders, necessitate routine screening in gambling treatment services. More complex psychological profiles may complicate treatment for problem gamblers with comorbid personality disorders. Future research should examine the applicability of the biosocial developmental model to problem gambling in community studies.     

Repairing ego deficits in children with developmental disorders

Children with developmental disorders have ego deficits which must be addressed before one is able to work with them in traditional dynamic clinical treatment. A review of the literature explores the distortions in personality structure which accompany developmental disorders, a conceptual paradigm for integration of psychodynamic and social learning theory models for understanding this problem, and suggestions for working with these children and their families. Three specific ego functions must be repaired in the initial stages of treatment: control of drive activity, reality testing, and the capacity for identification. Two case examples are used to illustrate how the worker may repair deficits in these ego functions.     

An Empowerment Approach in Teaching a Class about Autism for Social Work Students

Social workers are being asked to respond to the rapidly increasing number of individuals and families affected by Autism Spectrum Disorders (ASD). However, the curricula in schools of social work have limited content on disabilities. This article describes a course which prepares social work students for work with individuals with ASD through an empowerment approach in an ever-changing socio-cultural and political environment. This approach changes the focus of disabilities from a narrow perspective on particular services and rehabilitation to a broader concern with human rights, social inclusion and quality of life. The article describes the development of the course in collaboration with a university disability program, the areas of emphasis for the course (family focused, interdisciplinary, lifespan) and the multiple modes of delivery. The implications of teaching the course as an elective or as integrating it further into the curriculum are discussed.     

Effects of autism spectrum disorder on parental employment in the United States: evidence from the National Health Interview Survey

Using results of the US National Health Interview Survey (US-NHIS) for the years 1998–2013 we investigated the impact of having a child with autism spectrum disorder (ASD) on parents’ work behavior. After controlling for numerous background characteristics, we found that having a child with ASD lowered the number of hours of market work per week and the number of months of market work in the previous year for mothers. For fathers, having a child with ASD also reduced the number of hours of market work per week and the number of months of market work in the previous year. However, the magnitude of the effects were smaller for fathers than for mothers, and more sensitive depending on whether the estimates were derived from a linear regression model or propensity score models. Some evidence was also found that the impact of having a child with ASD on parents’ market work depended on whether or not the child with ASD also had an intellectual disability, the parent’s education level, immigration status, and parent race/ethnicity.     

Multisystemic Therapy for Disruptive Behavior Problems in Youths With Autism Spectrum Disorders: A Progress Report

Youths with autism spectrum disorders (ASD) often engage in serious disruptive behaviors that interfere with their ability to successfully manage day‐to‐day responsibilities and contribute to relationship problems with caregivers, peers, and teachers. Effective treatments are needed to address the factors linked with disruptive behavior problems in this population of youths. Multisystemic therapy (MST) is a comprehensive family‐ and community‐based treatment approach that has been effective with other difficult‐to‐treat populations of youths and holds promise for youths with ASD. In this article, we review the broad range of factors associated with disruptive behaviors among youths with ASD and discuss how MST interventions can be adapted to address those factors. We also present a framework for our adaptation of the MST model for youths with ASD. This framework includes a recently completed pilot study as well as an ongoing efficacy trial that together have served to identify key interventions for our adaptation of the MST model.     

Efficacy of a Facial Emotion Training Program for Children and Adolescents with Autism Spectrum Disorders

Twenty-five high-functioning, verbal children and adolescents with autism spectrum disorders (ASD; age range 8–15 years) who demonstrated a facial emotion recognition deficit were block randomized to an active intervention (n = 12) or waitlist control (n = 13) group. The intervention was a modification of a commercially-available, computerized, dynamic facial emotion training tool, the MiX by Humintell©. Modifications were introduced to address the special learning needs of individuals with ASD and to address limitations in current emotion recognition programs. Modifications included: coach-assistance, a combination of didactic instruction for seven basic emotions, scaffold instruction which included repeated practice with increased presentation speeds, guided attention to relevant facial cues, and imitation of expressions. Training occurred twice each week for 45–60 min across an average of six sessions. Outcome measures were administered prior to and immediately after treatment, as well as after a delay period of 4–6 weeks. Outcome measures included (a) direct assessment of facial emotion recognition, (b) emotion self-expression, and (c) generalization through emotion awareness in videos and stories, use of emotion words, and self-, parent-, and teacher-report on social functioning questionnaires. The facial emotion training program enabled children and adolescents with ASD to more accurately and quickly identify feelings in facial expressions with stimuli from both the training tool and generalization measures and demonstrate improved self-expression of facial emotion.